Maternal and Child Health

Correction to: Understanding the Family Impact of Autism Spectrum Disorder in a Racially and Ethnically Diverse Sample: Findings from the National Survey of Children with Special Health Care Needs The original version of this article unfortunately contained a mistake. The copyright permission below in Table 2 was inadvertently not published in the article.

Next Steps for Measures of Physical Activity During Pregnancy

Correction to: Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism? The original version of this article unfortunately contained a mistake in the analysis of the Tables 4 and 5.

Response Letter to: "Next Steps for Measures of Physical Activity in Pregnancy"

Associations of Socio-demographic, Family, and Neighborhood Factors with Physical Activity-Related Parenting Practices Among Hong Kong Preschoolers' Parents Abstract Objectives Regular engagement in physical activity (PA) has numerous health benefits in young children. Young children's parents can influence their children's PA behavior through different PA-related parenting practices. This cross-sectional study examined the independent contributions of socio-demographic, family/home and parent-perceived neighborhood environmental characteristics explaining PA-related parenting practices encouraging or discouraging PA among Hong Kong preschool-aged children (3–5 years-old). Methods Hong Kong Chinese preschoolers' parents were recruited from pre-selected kindergartens and Maternal and Child Health Centers located in areas stratified by residential density and socio-economic status. They self-completed socio-demographic, family/home and perceived neighborhood characteristics and PA-related parenting practices questionnaires. Generalized linear models were used to examine associations of socio-demographic, family/home and neighborhood variables with PA-related parenting practices. Results Socio-demographic and family/home characteristics were significantly correlated with parenting practices encouraging and discouraging PA. Parent-perceived neighborhood characteristics were significantly correlated with parenting practices discouraging PA only. Conclusions for Practice This study identified correlates of PA-related parenting practices among parents of Hong Kong Chinese preschoolers. The findings suggest future PA-promoting interventions among Chinese preschoolers via the promotion of parenting practices encouraging children's PA should consider multiple factors, including family relationships and childcare sharing, promotion of PA and its benefits among parents, and neighborhood social cohesion, traffic safety and safety from crime.

An Incentive-Based and Community Health Worker Package Intervention to Improve Early Utilization of Antenatal Care: Evidence from a Pilot Randomised Controlled Trial Abstract Objectives One of the factors linked to South Africa's relatively high maternal mortality ratio is late utilization of antenatal care (ANC). Early utilization is especially important in South Africa due to the high HIV prevalence amongst pregnant women. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on early utilization of ANC. Methods A pilot randomised controlled trial consisting of 72 women aged 18 and older was conducted in an urban area in South Africa to evaluate the impact of the package intervention. Women were recruited and randomised into either intervention (n = 39) or control group (n = 33). The intervention group received both the TBB and monthly CHW visits, while the control group followed standard clinical practice. Both groups were interviewed at recruitment and once again after giving birth. The outcomes measured are the timing of first ANC visit and whether they attended more than four times. It is anticipated that the box will also have a beneficial impact on infant health outcomes, but these fall out of the scope of this study. Results Women in the intervention groups sought care on average 1.35 months earlier than the control group. They were also significantly more likely to attend at least four antenatal clinic visits. Conclusions for practice Given the South African context and the importance of early care-seeking behaviour to improve health outcomes of HIV-positive pregnant women, the intervention can help to improve maternal and neonatal health outcomes. Further research is needed to investigate the impact of the two interventions separately, and to see if these findings hold in other communities.

Coordinating Outpatient Care for Pregnant and Postpartum Women with Opioid Use Disorder: Implications from the COACHH Program Abstract Purpose With the rise of opioid use disorder (OUD) among women of childbearing age, effective care models must address the complex needs of pregnant and postpartum women with OUD. This paper describes promising practices and implementation challenges from the Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) program, which utilizes a collaborative care team to coordinate outpatient care for pregnant and postpartum women with OUD. Description Semi-structured interviews were conducted with members of the COACHH team to discuss program logistics and takeaways. Interviews were coded to analyze themes. Assessment The COACHH team identified the need for specialized, time-intensive care coordination to address the unique needs of pregnant and postpartum women with OUD. First, the team prioritizes forming trusting relationships with patients to holistically understand patients' needs, improve patient engagement, and connect patients with resources. Second, the wide range of patient needs necessitates a team with diverse professional skills, whose members share an understanding of addiction and pregnancy. Third, finding the right quantitative outcome measurements is difficult; instead, success is measured in qualitative terms, stressing relationships and engagement as signals of change. Finally, the team encounters challenges with low referral rates, lack of provider awareness, and fragmented services. Conclusion We identified care delivery and program design considerations that may inform others who wish to coordinate care for pregnant and postpartum women with OUD. The program continues to face challenges enrolling patients and measuring outcomes, reflecting the need for tailored approaches and metrics for this population.

Ultra-processed Food Consumption by Pregnant Women: The Effect of an Educational Intervention with Health Professionals Abstract Objectives Nutrition during pregnancy is related with many maternal and child outcomes. To investigate the consumption of ultra-processed foods is one of the newest methods to evaluate food consumption, but these studies in pregnant women are rare. Methods We conducted a non-randomized controlled educational intervention on healthy eating and physical activity during pregnancy in primary health care units of Botucatu, São Paulo, Brazil. The sample comprised two groups of pregnant women with low obstetric risk, an intervention group (n = 181) and a control group (n = 172). The health professionals that assisted the pregnant women from the intervention group were trained to promote five healthy food practices during the prenatal care appointments: consumption of three fruits; two portions of vegetables; two portions of beans, at least 5 days per week; and restriction of soft drinks and industrially processed cookies. All pregnant women answered two 24-h dietary recalls per trimester, one face-to-face, another by telephone. The foods consumed by pregnant women were classified according Nova. The impact of the intervention on the ultra-processed food consumption was evaluated by multilevel linear regression analysis. Results A quarter of the energy consumed by the pregnant women provided from ultra-processed foods. The intervention reduced these percentage of energy between the first and second trimester of pregnancy by 4.6 points (p = 0.015). This effect was not observed in the third trimester of pregnancy. Conclusions for Practice Training health care professionals to promote healthy food practices is a viable and sustainable alternative to reduce ultra-processed foods during pregnancy.

Patterns of Health Insurance Discontinuity and Children's Access to Health Care Abstract Objectives This study classified patterns of discontinuous health insurance coverage, including change in coverage type and gaps in coverage, and described their associations with children's access to health care. Methods Using the 2011–2013 National Health Interview Survey data, we determined children's insurance coverage over the past year, and whether children had a usual source of care, had to delay getting care, or had unmet health care needs. Using multivariable logistic regression, we compared measures of access to care across insurance coverage patterns, classified as continuous private coverage; continuous public coverage; continuous lack of coverage; change in coverage type (public versus private) without gaps in coverage; and any gap in coverage. A subgroup analysis repeated this comparison for children with a caregiver-reported chronic physical illness. Results The analysis included 34,105 children, of whom 7% had a gap in coverage and 1% had a change in coverage type. On multivariable analysis, gaps in coverage were associated with increased likelihood of unmet health care needs, compared to continuous private (OR 6.9; 95% CI 5.9, 8.0) or continuous public coverage (OR 5.1; 95% CI 4.4, 6.0). Seamless changes in coverage were also associated with greater likelihood of unmet health care needs [OR vs. private: 3.8 (95% CI 2.3, 6.1); OR vs. public: 2.8 (95% CI 1.8, 4.6); all p < 0.001]. Results were similar for other study outcomes, and among children with chronic physical illness. Conclusions for Practice Both gaps in coverage and seamless changes between coverage types were associated with limited health care access for children.

Applying Organizational Health Literacy to Maternal and Child Health Abstract Purpose Describe the development of an innovative teaching activity that applies organizational health literacy to maternal and child health (MCH). Description Health literacy is a strong predictor of health behavior and outcomes. While the study of health literacy has traditionally been confined to skills and capacities of individuals, the significant role of the social and physical environmental contexts in facilitating or hindering one's ability to obtain, understand, and make informed decision about their health has been recognized. MCH organizations play a critical role in influencing health literacy across system levels. This teaching activity aims to equip students with knowledge and skills needed to foster organizational health literacy. Assessment The teaching activity is assembled within a toolkit which includes the following: (1) instructor lesson plan; (2) interactive PowerPoint presentation with instructor notes; (3) field assignment description; (4) health literacy attribute assessment worksheets; and (5) grading rubric. The teaching tool was pilot tested by a student research team member to assess the educational value and assignment logistics, resulting in minor edits (i.e., addition of interviewer probes, and option of a group project-format to permit triangulation of multiple organizational interviews). Conclusion The field of MCH is expanding in complexity, and the demands of health systems on women, children, and families must be mediated by conscious efforts within organizations. Through teaching the importance and function of organizational health literacy to students in MCH, educators can prepare an emerging workforce to improve health literacy, and ultimately the quality of healthcare for women, children, and families.